{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:04:46Z","timestamp":1780358686432,"version":"3.54.1"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthroplasty"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recovery from primary unilateral total hip arthroplasty (THA) is frequently impeded by pain and postoperative nausea and vomiting (PONV), which hinder Enhanced Recovery After Surgery (ERAS) goals. Although perioperative glucocorticoids offer a multimodal strategy to address these challenges, evidence remains inconsistent, and prior syntheses have often combined THA with total knee arthroplasty, preventing definitive conclusions. Therefore, we conducted this GRADE-assessed meta-analysis to determine the specific efficacy and safety of systemic glucocorticoids in primary unilateral THA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a comprehensive search of PubMed, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) published through October 17, 2025. Twelve RCTs met the inclusion criteria. Primary outcomes included pain (Visual Analog Scale, VAS), PONV incidence, opioid consumption, and glycemic control. Secondary outcomes included length of stay (LOS), C-reactive protein (CRP), interleukin-6 (IL-6), and complications. Risk of bias was assessed using the Cochrane RoB 2 tool. Data were pooled using a random-effects model, and results were expressed as mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1,128 patients were included in this meta-analysis. The pooled analysis revealed that systemic glucocorticoids were associated with a significant reduction in pain at rest (MD\u2009\u2212\u20090.20\u00a0cm; 95% CI\u2009\u2212\u20090.38 to\u2009\u2212\u20090.01;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200958.80%) and during walking (MD\u2009\u2212\u20090.50; 95% CI\u2009\u2212\u20090.89 to\u2009\u2212\u20090.12;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200986.06%). All observed pain reductions, including the most notable on postoperative day 1 (POD1) for walking pain (MD\u2009\u2212\u20091.19\u00a0cm), were below the THA-specific minimally clinically important difference (MCID) threshold of\u2009\u2212\u20091.86\u00a0cm, derived from acute postoperative pain measurements during the hospital stay (POD0\u20133). No differences were observed in postoperative glucose levels (MD\u2009\u2212\u20090.01\u00a0mmol\/L; 95% CI\u2009\u2212\u20090.15 to 0.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.84; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.00%). Glucocorticoids showed reductions in VAS nausea severity (MD\u2009\u2212\u20090.68; 95% CI\u2009\u2212\u20090.81 to\u2009\u2212\u20090.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.00%), PONV incidence (OR 0.21; 95% CI 0.13\u20130.35;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.00%), and rescue antiemetic use (OR 0.33; 95% CI 0.20\u20130.54;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.00%). An increase in flexion range of motion was observed (MD 6.82 degrees; 95% CI 2.12\u201311.52;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200994.05%), although this was based on a small number of trials with high heterogeneity. Within the studied timeframe and patient populations, no signal of increased harm was detected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Perioperative systemic glucocorticoids appear to modestly reduce early pain, though this reduction did not reach the MCID threshold. They were also associated with reduced PONV, shorter hospital stays, and lower inflammatory markers, without increasing short-term wound complications or infections in predominantly non-diabetic patients. Glycemic levels were not meaningfully affected in this population. Evidence for opioid-sparing effects remains inconsistent, and these results should be considered hypothesis-generating rather than definitive. Critically, these findings should not be extrapolated to diabetic patients, and routine use in this high-risk population cannot be recommended without targeted prospective trials. Future RCTs are needed to determine optimal dosing\u2014single intravenous dexamethasone 10\u201320\u00a0mg represents a reasonable candidate for investigation\u2014and to confirm safety in high-risk populations before formal clinical guidance can be established.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42836-026-00397-4","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T23:01:51Z","timestamp":1780354911000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative clinical efficacy and safety of perioperative systemic glucocorticoids in primary unilateral total hip arthroplasty: a GRADE-assessed meta-analysis of randomized controlled trials"],"prefix":"10.1186","volume":"8","author":[{"given":"Omar","family":"Abdelaziz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad G.","family":"Zayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abdo","family":"Khalafallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohamed","family":"Elsayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Islam Saeed","family":"Elhois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled A.","family":"Elmenawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"issue":"1","key":"397_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s42836-022-00156-1","volume":"5","author":"I Patel","year":"2023","unstructured":"Patel I, Nham F, Zalikha L, El-Othmani MM. 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